Provider Demographics
NPI:1851134142
Name:ENCHANTED LEGACY WELLNESS AND RECOVERY A PROFESSIONAL REGISTERED
Entity type:Organization
Organization Name:ENCHANTED LEGACY WELLNESS AND RECOVERY A PROFESSIONAL REGISTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:925-665-9851
Mailing Address - Street 1:720 CHICHESTER CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-4356
Mailing Address - Country:US
Mailing Address - Phone:661-218-0509
Mailing Address - Fax:661-427-2842
Practice Address - Street 1:720 CHICHESTER CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-4356
Practice Address - Country:US
Practice Address - Phone:661-218-0509
Practice Address - Fax:661-427-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty